After Mardi Gras—also known as Fat Tuesday—folks in Louisiana tend to fast during the Lenten season. Muslims fast from sunup to sundown for the entire month of Ramadan. Many Christian religions call for it when there’s a need to reinforce spiritual discipline or put a situation under concentrated prayer. Some people like to fast in the spring and fall, just as a way of “cleansing” and preparing for a new season.         

                Fasting—refusing food and sometimes drink for a specified period of time—is a commendable discipline, but it’s one you have to be very, very careful about if you have diabetes. Fasting comes with major risks for people with diabetes, including:

• Hypoglycemia, a drop in blood sugar due to decreased food intake
• Hyperglycemia, a blood-sugar spike that can happen when you aren’t taking as much medicine or when you begin to eat again after the fast
• Diabetic ketoacidosis, a reaction to insulin reduction and /or poor control diabetes prior to the fast
• Dehydration and thrombosis due to decreased fluid intake during fast.

                People with type 1 diabetes who experience poor glycemic control face the greatest risk of complications associated with fasting. You’ll have less risk of complications if your diabetes is well controlled; treated with metformin, thiazolidinediones, or diet alone; and if you are otherwise healthy.

                No matter what, if you choose to fast it should be thoroughly and carefully planned with your primary-care doctor and appropriate members of your diabetes dream team. To avoid exacerbating your condition, follow these general guidelines:

• Talk to your doctor prior to going on the fast to determine your individual risk factors and need to adjust your medication dosage and schedule while you’re fasting. Ideally you’ll schedule this assessment 1 to 2 months before you plan to fast.
• Discuss the fast with your spiritual leader. Because you have a health condition, you may be able to modify your fast in a way that meets your health objectives as well as your spiritual ones.
• You and your family should be aware of what to do in case you have a medical crisis. Know the signs and symptoms of hyperglycemia and hypoglycemia. Your fast should stop immediately if your blood glucose levels exceed 300 mg/dl or drop lower than 70 mg/dl. Also learn the appropriate treatment of hyperglycemia and hypoglycemia, including use of glucose tablets, glucose gels or glucagon injections.
• Wear a medical alert bracelet and keep emergency contact numbers in an obvious place—your wallet, in your car, under I.C.E. (in case of emergency) on your cell phone contact list.
• Monitor your blood glucose more frequently during a fast.
• Slow your workout. Too much exercise can lead to hypoglycemia. Type 1 diabetes patients may experience hyperglycemia.
• Plan your “break fast” carefully.  Many people break a fast with high-carb, high-fat foods. Avoid doing that. Continue your usual well-balanced meal plan after the fast.